Late antenatal care initiation and neonatal outcomes in an ethnically diverse maternal cohort

Abstract Background Ethnic minority status and maternal socio-economic deprivation are linked to delayed access to health care during pregnancy. The link between late antenatal care initiation and neonatal outcomes in settings with high ethnic diversity and social disadvantage is seldom explored. This study examined associations between late antenatal care initiation (first antenatal appointment >12 weeks gestation) and neonatal outcomes of preterm birth (<37 weeks gestation) and low birth weight (<2500 g) in an ethnically diverse socially disadvantaged maternal cohort. Methods A retrospective cross sectional study using routinely collected anonymous data of singleton births between April 2007 - March 2016 from a large UK National Health Service maternity unit in an ethnically diverse, socially disadvantaged area. Univariate and multivariate logistic regression models were used to examine the associations between late antenatal care initiation and prevalence of preterm birth and low birth weight. Results Of the 46,307 singleton births recorded, more than one third (34.8%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi mothers. Gestational week at first antenatal appointment was available for 99.31% births among which 79.2% had their first appointment at ≤ 12 weeks, 12% at 13-20 weeks, and 8.8% at > 20 weeks. Mothers who booked at 13+ weeks were significantly more likely to have a preterm and/or low birth weight baby. Compared to mothers who booked at ≤ 12 weeks, those booking at > 20 weeks were 4.08 times (95% CI: 3.29,5.07) as likely to have an extremely preterm baby (<28 weeks of gestation) and 3.12 (CI 2.66, 3.67) times as likely to have a baby born with extremely low birthweight (<1500g). Conclusions Mothers in ethnically diverse socially deprived areas who started antenatal care late were at increased risk of adverse neonatal outcomes. Targeted intervention programmes and services are needed to support these mothers. Key messages Mothers who start antenatal care late are more likely to have a preterm and/or low birth weight baby in ethnically diverse socially disadvantaged areas. There is a need for targeted programmes and services to support mothers in ethnically diverse socially disadvantaged areas to start antenatal care on time.


Background:
The optimal nutritional status of the mother is one of the most influential non-genetic factors for the healthy development of the fetus. In recent years, more and more scientific evidence has been accumulating that her dietary habits and nutritional status determine the fetal development and the health of the offspring.

Methods:
A cross -sectional study of pregnant women's dietary habits was conducted online. A questionnaire is attached, including questions about the diet, the frequency of consumption of certain food groups, application of alternative eating patterns and more. The analysis of the results is done with a software statistical package Jamovi ver. 2.3.0.

Results:
The servey is conducted among 117 women with a mean age of 30.4 AE 4.88 years. The majority of them have changed their dietary habits after registering a pregnancy (72.6%). Among all respondents, 18.8% haven't got a fixed diet. 67% of the respondents eat 3 -4 times a day, and 5.1% -less than three times a day. The relative share of pregnant women who consume milk and dairy products every day is 41% and 47%, respectively. None of the respondents restrains from consuming dairy products. Only 5.1% of the respondents do not consume milk. Six of the surveyed women (5.1%) do not eat meat and 14 (12%) do not eat fish. The relative share of women who eat fish 1 -2 times a week is 29.9%. The majority of women (88.9%) doesn't consume alcohol during pregnancy. The relative share of vegetarians is 6%. There are no vegans among the women surveyed.

Conclusions:
The majority of pregnant women surveyed follow the recommendations for healthy eating. There are women at risk of developing nutritional deficiencies among the respondents -macro -and micronutrients, which is a threat for maternal health, the course of pregnancy, as well as the growth and development of offspring. Key messages: The key to a normal pregnancy and primary prevention of complications is to establish healthy dietary habits. Malnutrition, overfeeding and unbalanced nutrition during pregnancy can adversely affect the offspring health at all stages of its live.

Background:
Ethnic minority status and maternal socio-economic deprivation are linked to delayed access to health care during pregnancy. The link between late antenatal care initiation and neonatal outcomes in settings with high ethnic diversity and social disadvantage is seldom explored. This study examined associations between late antenatal care initiation (first antenatal appointment >12 weeks gestation) and neonatal outcomes of preterm birth (<37 weeks gestation) and low birth weight (<2500 g) in an ethnically diverse socially disadvantaged maternal cohort.

Methods:
A retrospective cross sectional study using routinely collected anonymous data of singleton births between April 2007 -March 2016 from a large UK National Health Service maternity unit in an ethnically diverse, socially disadvantaged area. Univariate and multivariate logistic regression models were used to examine the associations between late antenatal care initiation and prevalence of preterm birth and low birth weight.

Results:
Of the 46,307 singleton births recorded, more than one third (34.8%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi mothers. Gestational week at first antenatal appointment was available for 99.31% births among which 79.2% had their first appointment at 12 weeks, 12% at 13-20 weeks, and 8.8% at > 20 weeks. Mothers who booked at 13+ weeks were significantly more likely to have a preterm and/or low birth weight baby. Compared to mothers who booked at 12 weeks, those booking at > 20 weeks were 4.08 times (95% CI: 3.29,5.07) as likely to have an extremely preterm baby (<28 weeks of gestation) and 3.12 (CI 2.66, 3.67) times as likely to have a baby born with extremely low birthweight (<1500g).

Conclusions:
Mothers in ethnically diverse socially deprived areas who started antenatal care late were at increased risk of adverse neonatal outcomes. Targeted intervention programmes and services are needed to support these mothers.

Key messages:
Mothers who start antenatal care late are more likely to have a preterm and/or low birth weight baby in ethnically diverse socially disadvantaged areas.
There is a need for targeted programmes and services to support mothers in ethnically diverse socially disadvantaged areas to start antenatal care on time. were unsure and 26% disagreed about the safety of the vaccine during pregnancy. Most of them did not deem the information received by HP complete (56%), clear (52%), and reliable (46%); 49% of them did not feel supported in their decision to vaccinate. This variable was the main predictor of vaccine hesitancy in addition to concern about vaccine safety in the multivariate model. Among women who felt unsatisfied 57% had an inadequate HL compared to 40% of those who had sufficient HL (p<.0001). The analysis of the open-ended questions also revealed a pervasive feeling of uncertainty.

Conclusions:
The study highlights how the lack of adequate communication and support by HP had a strong impact in the adherence to Covid-19 vaccination among pregnant women. Key messages: The lack of an effective communication by healthcare professionals contributed to the feeling of uncertainty and concern of pregnant women about Covid-19 vaccination.
There is a need to put effort on training for HP to improve their communication skills to support pregnant women's health decisions and improve their literacy in such a delicate phase of their life.